title: Neoadjuvant radiation therapy and its impact on complications after pancreaticoduodenectomy for pancreatic cancer: analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
abstract: OBJECTIVE
  This study investigated the impact of neoadjuvant radiation therapy (XRT) on postoperative outcomes following pancreaticoduodenectomy for pancreatic cancer.
  
  
  METHODS
  The American College of Surgeons National Quality Improvement Program database was queried for the period 2005-2010 to assess complication rates following pancreaticoduodenectomy for pancreatic cancer. Two groups of patients were identified, comprising those who received neoadjuvant XRT and those who did not (control group).
  
  
  RESULTS
  A total of 4416 patients were identified, including 200 in the XRT group and 4216 in the control group. There were differences in patient characteristics between the groups, including in age, hypertension and bilirubin level. Despite the fact that weight loss was more common, median operative time was longer (423 min versus 368 min; P < 0.001), and vascular reconstruction was more commonly required (20.5% versus 8.4%; P < 0.001) in the XRT group. In addition, the XRT group had a shorter median hospital stay than the control group (9 days versus 10 days; P = 0.005). Mortality (3.0% versus 2.7%; P = 0.818) and morbidity (40.5% versus 37.6%; P = 0.404) rates were not influenced by neoadjuvant XRT. Blood transfusion rates were increased in the XRT group (13.0% versus 7.4%; P = 0.003). Severe complications were influenced by age >70 years, American Society of Anesthesiologists (ASA) class >2, preoperative sepsis, dyspnoea, weight loss, impaired functional status, peripheral vascular disease and operative time of >8 h.
  
  
  CONCLUSIONS
  Neoadjuvant XRT is not associated with an increase in complications after pancreaticoduodenectomy.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Cancer Center, Portland, OR, USA.
authors.forename: Sung W
authors.initials: SW
authors.lastname: Cho
authors.forename: Ching-Wei David
authors.initials: CW
authors.lastname: Tzeng
authors.forename: W Cory
authors.initials: WC
authors.lastname: Johnston
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Newell
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States